Preventive versus “on-demand” nutritional support during antiviral treatment for hepatitis C: A randomized controlled trial

Background & Aims Although antiviral treatment for hepatitis C (HCV) is highly effective, side effects often occur, including weight loss, digestive symptoms, and impaired quality of life. We aimed at exploring the beneficial effects of preventive nutritional support. Methods In a randomized controlled trial, 53 HCV patients were allocated to "on demand" support (n=26: nutritional intervention if weight loss >5%) or preventive support (n=27: regular dietary advice plus energy- and protein-rich evening snack). Nutritional state (including validated Jamar Hand Grip Strength), digestive symptoms (visual analog score), and quality of life (SF-36 survey) were evaluated at baseline, and after 24 and 48weeks of peginterferon α-2b and ribavirin treatment. Results The primary end point (weight loss at 24weeks) was reached in 22 patients in both groups. Weight decreased markedly in the "on demand" group (decrease at 24weeks: 5.4kg or 6.9%, p p =n.s.). Jamar Hand Grip Strength deteriorated in the "on demand" group (from 40.3±15.5kg to 32.0±13.1kg, p p =n.s.). Intake of energy, proteins, and fat decreased markedly in the "on demand" group but increased in the preventive group. Although digestive symptoms and quality of life deteriorated, impairment was significantly less in the preventive group. Conclusions Preventive nutritional advice plus supplementation prevents weight loss and catabolic state during HCV antiviral therapy, with improved digestive symptoms and quality of life.